Healthcare Provider Details

I. General information

NPI: 1881505592
Provider Name (Legal Business Name): VICKI MAH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 ELVAS AVE
SACRAMENTO CA
95819-1913
US

IV. Provider business mailing address

3702 41ST AVE
SACRAMENTO CA
95824-2510
US

V. Phone/Fax

Practice location:
  • Phone: 916-613-7099
  • Fax:
Mailing address:
  • Phone: 916-613-7099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number19370
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: